Satisfaction with care provided by home‐based palliative care service to the cancer patients in Dhaka City of Bangladesh: A cross‐sectional study

Abstract Background and Aims Patient satisfaction is an important quality indicator of health care service. The concept of home‐based palliative care has been recently introduced in Bangladesh, but the patients' satisfaction with this care remained unexplored. This study aimed to assess the satisfaction of the cancer patients receiving this care. Methods This cross‐sectional study was conducted among 51 surviving cancer patients above 18 years of age registered under the home‐based care service of the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Data were collected by face‐to‐face interviews using a structured questionnaire based on the FAMCARE P16 questionnaire from February to March 2019. Descriptive analysis was done for the sociodemographic and satisfaction‐related indicators. A correlation matrix was done to see the correlation among the satisfaction indicators. Result The majority of the patients (88.2%) were satisfied with the service provided by the home care team. Most (76.5%) of the patients were women, and the mean age was 56.25 ± 14.8 years. The median duration of getting home‐based care was 4 months. Main satisfaction indicators were—assessment of physical symptoms (70.6%), providing information about pain management (70.6%), the inclusion of the family in decision making (76.5%), coordination of care between the members of the home care team (84.3%) and availability of doctors, nurses and palliative care assistants (74.5%). A high correlation was observed between satisfaction regarding the care of physical symptoms and provision of information (R = 0.814, p < 0.001). Also, satisfaction regarding the provision of information and support provided to the family is highly correlated (R = 0.722, p < 0.001). Conclusion Despite the limitations, the overall satisfaction level of the patients regarding home‐based palliative care services in Bangladesh is very high. Home‐based palliative can be a solution to provide palliative care to patients who are unable to access institution‐based care and improve their quality of life.

Home-based palliative can be a solution to provide palliative care to patients who are unable to access institution-based care and improve their quality of life.

K E Y W O R D S
Bangladesh, cancer, home-based palliative care, palliative care, patient satisfaction 1 | BACKGROUND Palliative care is a holistic approach that focuses on improving the quality of life of patients with life-limiting illness and their families by assessment and prevention of physical, psychosocial, and spiritual sufferings. 1 In the last few decades, there is an enormous growth in the field of palliative care, and it has been integrated into the mainstream health care system in many countries. [2][3][4][5] Still, about 40 million people worldwide are in the need of palliative care, 34% of them are diagnosed with cancer of different stages, but only about 14% of them are currently receiving this care. 6 The diagnosis of cancer itself and its treatment-related side effects give rise to various physical, psychosocial, and spiritual sufferings. 7 It has been evidenced that palliative care helps this patient and their families to deal with these problems. 1 Among different palliative care delivery system models, the cost-effectiveness and higher patient satisfaction reported in home-based palliative care services increased the popularity of this service around the world. 8 Although in many countries, palliative care is an essential part of the health care system, in many lower-middle and lower-income countries, the concept of palliative care is still new. In Bangladesh, there are some isolated initiatives of providing home-based palliative care have been taken. Approximately 0.6 million patients need palliative care in Bangladesh, but less than 4000 people have received this care until now. 9 The PCA includes specially trained individuals who do the initial visits. other. 12 Evaluation of patient satisfaction is necessary to assess the quality of the service and planning for necessary intervention.
Improving patient satisfaction leads to improving the quality of the service.

| Sample criteria
All the surviving cancer patients who registered under this service up to February 2019, above 18 years of age, willing to participate, and got at least three visits from the home care team were included in the study. Those who were delirious, disoriented, or unable to communicate were excluded. Those caregivers (paid or family members) who take care of the patients at least 5 days per week are included in the study. Occasional caregivers were excluded.

| Sample size
According to the Center of Palliative Care (CPC) database up to February 2019, the number of registered cancer patients receiving home-based palliative care was 60. During data collection three patients died, four patients were not eligible for the study due to delirium, and three patients refused to give informed consent. So the final sample size of the study was 51.

| Instruments
The questionnaire had two major parts. The first part contained the sociodemographic, disease, treatment, and primary caregiver-related information collected from the hospital record.

| Data collection procedure
Initial data were collected from the hospital case sheets (sociodemographic information, diagnosis and treatment history, caregiverrelated information).
The investigators accompanied the home care team to the patients' home, and the interviews were conducted in their presence. The patients and the caregivers were recruited in pair and were interviewed together. The duration of each interview was 30 minutes to 1 hour. Very frail patients were given multiple visits to complete an interview. The level of satisfaction was presented in three categories based on mean and SD. The value below lower limit of mean − 1 SD was categorized as not satisfied, the range between upper and lower limit of mean ± 1 SD was categorized as satisfied and the value above mean + 1 SD was categorized as very satisfied.

| Data analysis
Correlation matrix was done to see the correlation among the satisfaction indicators. p < 0.05 was considered as significant.

| RESULTS
The majority (76.5%) of the patients were women, and the mean age  provision of information (R = 0.814, p < 0.001), followed by satisfaction regarding the support given to the family (R = 0.759, p < 0.001).
Also, satisfaction regarding the provision of information and satisfaction regarding the support given to the family were highly and significantly correlated (R = 0.722, p < 0.001) ( Table 3).

Home-based palliative care has been introduced recently in
Bangladesh. This is the first study in Bangladesh assessing the satisfaction with the care of the patients' receiving such care. One major limitation of this study is that this study was conducted on the home-based palliative care service provided by a single institution, so the findings of the study cannot be generalized.
Also the greater picture of home-based palliative care in Bangladesh is not reflected in this study. Due to the cross-sectional nature of this study, the perception of satisfaction among the patients cannot be measured over time.

CONFLICT OF INTEREST
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are openly available

TRANSPARENCY STATEMENT
The lead author Jheelam Biswas affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.